Department of Health Psychology, University of Mirail, Toulouse, France.
Health Commun. 2011 Oct;26(7):649-55. doi: 10.1080/10410236.2011.561919. Epub 2011 May 23.
The objective of this study was to ascertain how patients judge the acceptability of physicians' communication of bad news. Two hundred forty-five adults, who had in the past received bad medical news, indicated the acceptability of physicians' conduct in 48 vignettes of giving bad news to patients. Vignettes were all combinations of five factors: level of bad news (infection with hepatitis C, cirrhosis of the liver, or liver cancer); request or not to the patient to come with spouse or partner; attempt or not by the physician to find out the patient's expectations about the test results; presence or absence of emotional supportiveness; and provision or not of complete and understandable information. In addition, nine physicians rated the same vignettes. Quality of information and emotional supportiveness explained more than 95% of the variance in patients' acceptability judgments, while the degree of badness of the news had no impact. In addition, for patients, low emotional supportiveness could not be fully compensated by high quality of information, nor the inverse. Physicians, in contrast, responded as if such compensations were possible. Physicians must appreciate that patients expect high levels of both empathy and information quality, no matter how bad the news.
本研究旨在确定患者如何判断医生传递坏消息的可接受性。245 名成年人过去曾收到过坏的医疗消息，他们在 48 个向患者传递坏消息的情景中对医生的行为表示可接受的程度。情景都是由五个因素的所有组合：坏消息的严重程度（丙型肝炎感染、肝硬化或肝癌）；是否要求患者带配偶或伴侣来；医生是否试图了解患者对测试结果的期望；是否有情感支持；以及是否提供完整且易于理解的信息。此外，有 9 名医生对相同的情景进行了评分。信息质量和情感支持解释了患者可接受性判断中超过 95%的差异，而消息的严重程度没有影响。此外，对于患者来说，低水平的情感支持不能被高质量的信息完全弥补，反之亦然。相比之下，医生的反应似乎表明这种补偿是可能的。医生必须认识到，无论消息多么糟糕，患者都期望高水平的同理心和信息质量。
